(This post was previously published in a 2004 issue of Perspectives, the newsletter of the New Jersey Academy of Family Physicians.)
The doctor is never off duty.
I learned this firsthand the summer after graduating from medical school. The ink on my diploma had barely dried when I embarked on a week-long vacation to Greece. Our tour group assembled in a hotel in Athens, where we met our tour guide, Marianna, a transplanted Swede with a penchant for astrology and the word “perhaps.”
She laid out our itinerary. We were to spend one day in Athens, then board a bus that would take us to the rest of our destinations–Pylos, Mycenae, Mystra, Sparta, and Olympia, to name a few. It sounded heavenly. Eight whole days away from medicine, in a country I’d always wanted to visit–a country that fascinated me with its mythology, its culture, its food. Breath-taking vistas, ancient ruins, and all the moussaka I could eat. I couldn’t wait.
My time in Greece was everything I’d expected until the third day. That morning, as I sat down with my traveling companions for breakfast in a hotel in Pylos, Marianna approached me. “Would you come with me for a moment?” she asked.
I followed her out of the dining room and down the stairs. We stopped outside one of the guest rooms. The door was closed. Before touching the doorknob, Marianna turned to me.
“You said you were a doctor, is that right?” she asked.
I opened my mouth, closed it, and opened it again. At the beginning of our journey, in an attempt to make conversation, she’d asked me what I did for a living. I’d explained that I’d just graduated from medical school and would now be training as a doctor. Now something in her voice made me regret my candor.
I tried to breathe past the knot in my stomach. “Um…a very new doctor, yes.”
She paused. “There is an old lady in our group, Betty–perhaps you’ve met her already. No? She is not feeling well. Diarrhea and cramps.” She waved her hands helplessly. “I don’t know why this is happening. Perhaps Mercury is retrograde. Perhaps you could take a look?”
I was about to protest that I was on vacation, that I had earned a break after four years of myopia-inducing medical study, that I didn‘t even have my stethoscope. Then I realized something: doctoring was not something I could turn on and off. During medical school, I’d led a sort of double life, shedding my white coat every weekend and returning to my medical student persona. Now that I had my M.D., I couldn’t choose when I wanted to be a doctor. I was a doctor even while I slept.
So despite the cramps building in my own stomach, I followed Marianna into the room to evaluate my very first patient.
The woman, Betty, was about seventy years old and dressed in sweatpants and a short-sleeved T-shirt. She lay on the made-up bed. I was relieved to see that she didn’t look particularly sick. A fortyish woman–her daughter, I assumed–was sitting in a chair next to the bed.
Marianna skipped over my name and went right to my title. “This is a new doctor,” she introduced me.
Betty managed a smile. “I don’t know what happened to me,” she said, almost apologetically. “This morning I just woke up and my stomach hurt so bad. And then I got the runs.”
Chief complaint covered. “Can you tell me about the pain?“
“It’s crampy. It comes and goes.“
“Where is the pain?”
Betty rubbed her left lower abdomen ruefully.
Well, it wasn’t likely to be the appendix. “Are you nauseated?”
“No.”
“Fever?”
“I don’t think so.”
“Can you tell me about the diarrhea?”
“Just once,“ she said. “Real watery.”
“Any blood in it?”
“No.”
“Have you had this before?”
“No.”
“How old are you, Betty?”
“Seventy-two.”
“Any other health problems? Medications?”
The daughter spoke up. “Not really. She’s healthy as a horse.”
A long pause. I realized I‘d exhausted my history-taking skills. Gingerly, I poked at Betty’s abdomen. It was soft, nontender, nondistended, without rebound. I poked a little longer, stalling for time. Without my stethoscope, I couldn’t even listen to her belly. I was stuck.
Betty’s daughter spoke up suddenly. “The diarrhea seems to have calmed down. Her main problem’s the pain. I was thinking we could give her some Bentyl or something.”
She must have seen the look on my face, because she explained, “I’m a nurse back home in Virginia.”
Half of me thought, Great. Like I need more pressure. The other half broke into the Hallelujah chorus.
“Yes,” I said, trying to sound confident and authoritative. “Yes, I think that would be useful, too.”
“Except I don’t have any with me.”
The hallelujahs died abruptly. I tried to think. Here I was in a foreign country, faced with my very first patient, and I was untested, unlicensed, and unequipped. Not the most auspicious start to my medical career.
Marianna spoke up. “Perhaps there is a pharmacy in town. Perhaps we could drive past on our way out of Pylos?”
We all agreed that this was the best thing to do. Having finished breakfast, our group piled onto the bus and the driver took us into the town center, where we found a pharmacy. Betty’s daughter got off the bus. Marianna got off the bus. Trying to avoid the curious looks of my traveling companions, I got off too.
Inside the pharmacy, the air smelled of menthol and camphor. The store was modern and clean, with whitewashed walls and a shiny linoleum floor. It was, however, barely big enough to hold all three of us as Marianna explained our situation in fluent Greek to the girl behind the counter. I understood only one word as Marianna pointed to me: iatros.
The girl nodded. She had a beautiful olive complexion and seemed eager to help. Marianna turned to Betty’s daughter. “What is the name of the drug that you need?”
“Bentyl,” was the immediate reply.
The olive-skinned girl shook her head. She didn’t recognize that name.
“It’s for intestinal cramps,” I said. “An antispasmodic.” I was starting to panic. Here was another unforeseen complication: the language barrier. If we didn’t find the medication soon, I was going to need some myself.
Marianna translated. The girl’s eyes lit up, and she reached for a small box on the second shelf behind her. In rapid Greek, she spoke to Marianna for a few seconds, turning the box over and pointing to the label that listed the active ingredients. I leaned over to take a look. The label, like everything else, was Greek to me.
Marianna was telling us, “This is a very good medication for cramps and diarrhea.”
Laboriously, letter by letter, I translated the Greek. HYOSCYAMINE. Something clicked. I turned to Betty’s daughter. “Hyoscyamine. Isn’t that Levbid?”
“I think so.”
I’d seen Levbid used for intestinal cramps before. “Okay,” I told Marianna. “We’ll try it.”
The girl put the box in a package and we paid for it. Betty’s daughter also bought bottled water from a vendor on the sidewalk, and we got back on the bus, where Betty took one of the pills and washed it down with several swallows of water.
Then we were on our way again. From my seat near the window, I had a fantastic view of the Greek coastline–rugged mountainous terrain falling off into pristine white beaches. I’d chosen the window seat for this very reason, but somehow I couldn’t concentrate on the scenery. I worried that I’d given Betty the wrong medication. I worried that she really needed to go to a hospital. I worried that I hadn’t been thorough enough in my examination. I worried.
When the bus stopped again, it was lunchtime, and all of us exited the bus to sit on a cool, shady restaurant veranda. Waiters brought us trays of moussaka, Greek salad, and lamb kebabs. Betty was sitting with her daughter and grandson at a table not far from mine. I excused myself and went to their table, touching Betty lightly on the shoulder. She turned in her chair and gave me a smile.
“I’m feeling so much better,” she said. “I don’t know what happened this morning, but I guess it was just that once. Thank you.”
“If you feel sick again, you let me know,” I told her.
“I think I’ll be just fine,” she said. “Don’t trouble yourself about me.”
I knew though, as I went back to my lamb kebabs, that I would trouble myself about her for the rest of the day, and possibly for the rest of the week. I was a doctor, after all. Even on vacation. In Greece. Without my stethoscope.
